Nokea
A 5-year-old child who had a repair for transposition of the great arteries shortly after birth is growing normally and has been asymptomatic since the surgery. The primary care nurse practitioner notes mild shortness of breath with exertion and dizziness. What will the nurse practitioner do?
- A. Order an echocardiogram and chest radiograph.
- B. Perform pulmonary function testing.
- C. Reassure the parent that these symptoms are common.
- D. Refer the child to the cardiologist immediately.
Correct Answer: D
Rationale: Children with a history of transposition of the great arteries (d-TGA) who have a history of palpitations, syncope, or shortness of breath should be referred to a cardiologist.
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Consequences of a median nerve section in the ante-cubital fossa include:
- A. Complete paralysis of pronation
- B. Loss of sensation over palmar aspect of middle finger
- C. Wasting of hypothenar eminence
- D. Paralysis of abductor pollicis brevis
Correct Answer: D
Rationale: The median nerve controls the abductor pollicis brevis, and its injury at the ante-cubital fossa results in an inability to perform thumb abduction.
The following criteria are indications for further investigation of premature ventricular contractions (PVCs) that could require suppressive therapy EXCEPT
- A. multiform PVCs
- B. disappear during exercise
- C. R-on-T phenomenon
- D. extreme frequency of beats
Correct Answer: B
Rationale: PVCs that disappear during exercise are less concerning and do not necessarily require suppressive therapy.
Defects of complement system should be suspected in:
- A. Recurrent folliculitis
- B. Facial swelling following trauma
- C. Recurrent meningococcal infection
- D. Pneumocystis carinii pneumonia
Correct Answer: C
Rationale: Recurrent meningococcal infection: Defects in the complement system, especially the terminal complement components, increase the risk of recurrent meningococcal infections.
An adolescent female has a history of repaired tetralogy of Fallot (TOF). Which long-term complication is a concern for this patient?
- A. Aortic stenosis
- B. Chronic cyanosis
- C. Mitral valve prolapse
- D. Ventricular failure
Correct Answer: C
Rationale: Patients with repaired TOF, especially adolescent females, are at risk for mitral valve prolapse.
Recognised features of myotonic dystrophy include:
- A. Phenomenon of anticipation
- B. Muscle pain
- C. Diplopia
- D. Cardiomyopathy
Correct Answer: A
Rationale: The phenomenon of anticipation, where symptoms become more severe or appear at an earlier age as the disorder is passed through generations, is a recognized feature of myotonic dystrophy.